ICU Telemedicine & Inter-Hospital Transfers

Previous studies have extensively investigated the effect of ICU telemedicine on mortality and hospital length of stay. However, little is known regarding the effect of ICU telemedicine on inter-hospital transfers.To gain a better understanding of this association, Spyridon Fortis, MD and colleagues analyzed Veterans Affairs ICUs in 117 acute care facilities between 2011 and 2015. The team compared inter-hospital transfer rates in ICU telemedicine-affiliated hospitals with transfer rates of facilities with no telemedicine program.

“Often, ICU patients in low-resource ICUs are transferred to other facilities to receive care,” says Dr. Fortis. “These patients are not included in the vast majority of studies. This is probably one of the reasons that some previous studies have shown no benefit from ICU telemedicine. For that reason, we focused on transfers rather than mortality and length of stay.”

A total of 553,523 admissions to Veterans Affairs ICUs (97,256 to telemedicine hospitals; 456,267 to non-telemedicine hospitals) were analyzed. Transfers decreased from 3.46% to 1.99% in the telemedicine hospitals and from 2.03% to 1.68% in the non-telemedicine facilities between pre- and post-telemedicine implementation periods. After adjusting for demographics, illness severity, admission diagnosis, and facility, ICU telemedicine was associated with overall reduced transfers with a relative risk (RR) of 0.79. This reduction occurred in patients with moderate (RR, 0.77), moderate to high (RR, 0.79), and high illness severity (RR, 0.73) as well as in nonsurgical patients (RR, 0.82.)

“Telemedicine is another tool for small, rural, low-resource ICUs with limited or no availability of an intensivist,” says Dr. Fortis.